Don’t get sick
A trans-Atlantic cat fight is underway about just who has the worst health care system.
‘Surely it’s the Canadians?’ you’re no doubt thinking. But no. With handbags at 10 paces, the US Republicans have squared off against the British left and they’re batting each other with soft leather as the prescription papers fly, each claiming the other has a barbaric medical system.
Evil and Orwellian
In the US, Republicans are using the NHS to scare Americans into opposing President Barack Obama’s health care reform plans. Calling the British system ‘evil and Orwellian’, they’ve run advertisements that claim the Obama plan would, like the NHS, ration health care, deny the elderly and the terminally ill life-lengthening drugs, stop people from seeing specialists, create a government barrier between the general public and care.
GOP grassroots groups have run an expensive advertising campaign that shows the union flag and Big Ben as a voice intones ‘$22,750. In England, government health officials have decided that’s how much six months of life is worth. If a medical treatment costs more, you’re out of luck’
#welovetheNHS
The British Medical Association responded in tones of outrage and wounded pride, insisting that life expectancy in the UK is longer than in the US. One anonymous representative of the BMA said, ‘Doctors and the public here are appalled that there are so many people in the US who don’t have proper access to health care. It’s something we would find very, very shocking,’ she said.
The BBC supportively showed scenes of people in Los Angeles waiting to enter a free clinic and the reporter said, breathlessly (and quite wrongly), ‘This is the only place for the unemployed and the poor to get health care.’
On Twitter, so many people in the US were writing posts about being scared of the NHS that ‘NHS’ became a trending topic. Almost immediately Britain responded en masse, making ‘#welovetheNHS’ a trending topic, as thousands of people wrote about how they have the best health care system in the world right here in the UK.
Get a grip
As ever, there is some truth in the words of each side.
The GOP ads might be insulting, but nobody’s saying they’re untrue. They just seemed outraged that it’s being said at all.
And if you look at what is alleged in the ads, well, that is what the NHS does.
It just sounds so negative when they say it like that. All accusing like.
Face it: In England the hospitals are run by the government. Doctors are hired by the government. Doctors are the government. Government officials make awful managers. And bad doctors.
Hospitals are filthy, and people die because of it, and primary health care varies wildly in both quality and thoroughness. Access to specialists is controlled by the government, so if your GP has been told not to make referrals, you won’t get to see a specialist. Waiting lists for everything are absurdly long, medical tests take weeks to complete, and people die because of all of it.
That is insane.
And the American system? Well, the American medical system is outstanding. One of the best in the world. And so well funded. If you have ever been very ill, wherever you live in the world, odds are some element of your survival had something to do with American medical research.
The problem is, not all Americans have access to that high-quality health care. In the US, if you are poor, the government funds a not-very-good free basic health care system for you, much like the NHS. If you are middle class and permanently employed, your health insurance plan probably provides damn good care. Unless you actually do get sick. In which case they just might drop you, and then no insurance company in the country will pick you up again.
The problem with the US system is that it is riddled with holes. The lower middle class, the self-employed, those who work for small companies, and the chronically ill all fall through its cracks. Neither the government nor insurance companies protects those people, and there are millions of them. A huge percentage of the population – between 20% and 30% of the working-age population – is uninsured and does not qualify for government health care. Many parents can’t afford to insure their children, so then young people don’t get the health care they need.
Before this recession hit, the leading cause of homelessness in the US was illness.
That is insane.
Take it from me
I have lived in both countries. And I can say that without a doubt the level of care I received in the US was consistently better. Doctors were more experienced and compassionate. The drugs I was prescribed for illnesses were more varied and better chosen. My care was better monitored. Specialists were routinely suggested if I developed problems.
I had the same GP for 10 years even though I moved constantly. I could see him no matter where I lived if I was willing to make the trip, and I was willing because he was brilliant.
But I did not have health insurance so I saw specialists only as a last resort, and I had to save up for it, or put it on my credit card. When my doctor prescribed drugs he often gave me free samples so I wouldn’t have to pay the outrageous prescription fees.
I never had a catastrophic illness, so I never had to face that awful situation. But a few years ago, I knew somebody whose wife was having a baby, and they had saved up $10,000 in advance of the birth in case there were complications.
By contrast, in the UK I’ve seen probably a dozen different GPs over the years. Every time I move, I must register at a new surgery, be assigned at random a GP who does not know me. Wait months for my records to transfer. Begin again the process of convincing them that my health problems are legitimate. Have the same tests again.
With one exception, all the GPs I’ve seen have lacked compassion, behaved like androids and been slaves to their computers. I’ve found them to be overwhelmingly complacent, insulting, lazy and scary. I found the lack of choice in this system depressing and difficult to accept.
I never once in America thought I could die from illness. In the UK on several occasions I have seriously wondered if I would survive. Each time my GP couldn’t have cared less.
I once sat on the pavement outside my GPs surgery in London, too sick to go home. The doctor I’d spoken with on the phone 30 minutes before had forgotten to tell me the surgery closed every day from noon to 2pm. For paperwork.
A stranger on the street helped me get a cab. The cab driver told me that he thought the health care he received in prison had been better than the care he got from the NHS now that he was out of jail.
But I’ve never had to pay a dime. I do not risk losing everything if I get cancer.
The problem I have is: Everyone’s treatment is free, yes. But that treatment is of such dubious quality that it’s hard for me to say that British people are better off than the Americans who re-mortgage their house to pay for an operation. At least the Americans get the operation, and they can choose their hospital and their surgeon.
An apple a day
What I’m trying to say is this: Both systems are unacceptable.
The British system is authoritarian, grim, unbelievably dirty, dangerous, depressing, badly run and the GPs seem to have either limited medical knowledge or astonishingly poor communications skills.
The American system is unfair, too expensive, results in too many people going to emergency rooms for routine care, leaves people at the mercy of greedy insurance companies, and destroys lives.
Both systems have something to offer. The completeness of the British system – the way it ensures everybody gets some basic health care - and its obsession with the elusive idea of fairness is impressive.
The richness of the American system – the way it values and rewards research and spares no expense or time in trying to save lives – and the compassion shown by its doctors should be the goal of all health care systems.
What the Obama plan is trying to do, I suspect, is bring in more completeness without losing the richness. There’s no guarantee that he will be able to do that, as democracy is ever a study in compromise and there is blood in the water right now. But at least he is trying, and a debate is underway.
In Britain, though, I suspect there will be no debate at all. For the population has been presented with a bogeyman. Sitting right next to France with its outstanding healthcare system, it looks only west, pointing a tremulous finger across the Atlantic and saying ‘We love the NHS! Best health care system in the world! We don’t want to be like America.’
If the discussions in both countries were less hysterical and nationalistic, both could have systems more like the one in France, which offers an interesting combination of the American and UK systems; it costs more than the British system but less than the American and actually seems to work better than either of them.
Please shut up
The thing that gets me is how similar the right-wing Republicans’ scare tactics are to those used by the largely left-wing pro-NHS contingent in Britain. Each creates a simplistic caricature of the other system and uses it to stymie badly needed change.
Each country could learn something from the other, and each could take some caution from the other’s mistakes. But as long as the loudest voices are the most extreme, everybody will suffer.
So please, see that the answer is somewhere in between. Don’t be brainwashed. For your own sake, acknowledge the weaknesses in whichever system you unfortunately have where you are.
And whether you live in America or Britain, until more rational minds prevail, my advice is this – Don’t get sick.
